Brain functional connectivity with rehabilitation in children with co-occurring autism spectrum disorder and developmental coordination disorder

Children with co-occurring autism spectrum disorder (ASD) and developmental coordination disorder (DCD) show improved motor function after Cognitive Orientation to daily Occupational Performance (CO-OP) intervention; however, it is unknown whether CO-OP induces changes in brain function in this clinical population. The objectives of this study were to: (1) investigate changes in functional connectivity in children with ASD+DCD after CO-OP; (2) determine whether brain changes are maintained three months post-intervention; and (3) explore the relationship of functional connectivity changes with improved motor function. In this study, 24 children with ASD+DCD were randomly assigned to either a treatment or waitlist group and underwent three resting-state MRI scans over six months. The treatment group received intervention between the first and second scan; the waitlist group received intervention between the second and third scan. After CO-OP, participants showed increased functional connectivity in the left precentral gyrus and right middle frontal gyrus (Cohen’s d=0.76 and 0.79, respectively). Brain changes were maintained three months post-intervention. Regression analysis revealed increased connectivity between the sensorimotor network and left insular cortex, correlating with motor outcomes. CO-OP was associated with clinically meaningful increases in functional connectivity, providing further evidence that CO-OP is effective for children with ASD+DCD. • Autistic children (without intellectual disability) with DCD benefit from CO-OP. • CO-OP intervention induces greater functional connectivity in frontal regions. • Increased functional connectivity correlated with better motor outcomes.